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Abstract：
BACKGROUND: Prognostic research in low back pain (LBP) is essential for understanding and managing the condition. This study aimed to, (1) describe the proportions with mild-moderate and severe pain and disability at baseline, 1-year and 4-year follow-up, and (2) investigate prognostic factors for improvement in pain and disability over 4 years in a cohort of secondary care LBP patients.
METHODS: This was a secondary analysis of a cohort of patients with LBP aged 18-40 years recruited from a non-surgical outpatient spine clinic between March 2011 and October 2013 (n = 1037). Questionnaires were collected at baseline, 1-year, and 4-year follow-up. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ 0-100) and pain intensity using the Numeric Rating Scale (NRS 0-10). \'Mild-moderate pain\' was defined as NRS < 7 and \'severe pain\' as NRS ≥ 7. Likewise, \'mild-moderate disability\' was defined as RMDQ < 58.3, and \'severe disability\' was RMDQ ≥ 58.3. In the prognostic analysis, improvement in pain and disability over 4 years was defined as meeting both criteria: decrease of ≥ 2 on the NRS and of ≥ 20.8 on the RMDQ. Sixteen candidate prognostic factors were assessed by multivariate logistic regression.
RESULTS: Among patients with information available at all three time points (n = 241), 54%/48% had persistent mild-moderate pain/disability, while only 7%/15% had persistent severe pain/disability. Of patients included in the multivariate prognostic analysis regarding improvement over 4 years (n = 498), 32% had improved in pain and disability after 4 years. Positive associations were found for pain intensity (OR 1.34 [95%CI: 1.17-1.54]), disability (OR 1.01 [1.00-1.02]), and regular employment or studying (OR 1.67 [1.06-2.64]), and negative associations for episode duration (OR 0.99 [0.99-1.00]) and risk of persistent pain (OR 0.58 [0.38-0.88]).
CONCLUSIONS: Patients with persistent LBP in secondary care had mostly mild-moderate pain and disability consistently at all three time points, with few having consistently severe symptoms over 4 years. Moreover, approximately half of the included patients improved in pain and disability. We found that pain intensity, disability, episode duration, regular employment or studying, and risk of persistent pain predicted a long-term improvement. However, the limited availability of complete follow-up data may affect generalisability.
METHODS: This was a secondary analysis of a cohort of patients with LBP aged 18-40 years recruited from a non-surgical outpatient spine clinic between March 2011 and October 2013 (n = 1037). Questionnaires were collected at baseline, 1-year, and 4-year follow-up. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ 0-100) and pain intensity using the Numeric Rating Scale (NRS 0-10). \'Mild-moderate pain\' was defined as NRS < 7 and \'severe pain\' as NRS ≥ 7. Likewise, \'mild-moderate disability\' was defined as RMDQ < 58.3, and \'severe disability\' was RMDQ ≥ 58.3. In the prognostic analysis, improvement in pain and disability over 4 years was defined as meeting both criteria: decrease of ≥ 2 on the NRS and of ≥ 20.8 on the RMDQ. Sixteen candidate prognostic factors were assessed by multivariate logistic regression.
RESULTS: Among patients with information available at all three time points (n = 241), 54%/48% had persistent mild-moderate pain/disability, while only 7%/15% had persistent severe pain/disability. Of patients included in the multivariate prognostic analysis regarding improvement over 4 years (n = 498), 32% had improved in pain and disability after 4 years. Positive associations were found for pain intensity (OR 1.34 [95%CI: 1.17-1.54]), disability (OR 1.01 [1.00-1.02]), and regular employment or studying (OR 1.67 [1.06-2.64]), and negative associations for episode duration (OR 0.99 [0.99-1.00]) and risk of persistent pain (OR 0.58 [0.38-0.88]).
CONCLUSIONS: Patients with persistent LBP in secondary care had mostly mild-moderate pain and disability consistently at all three time points, with few having consistently severe symptoms over 4 years. Moreover, approximately half of the included patients improved in pain and disability. We found that pain intensity, disability, episode duration, regular employment or studying, and risk of persistent pain predicted a long-term improvement. However, the limited availability of complete follow-up data may affect generalisability.
摘要：
背景：下腰痛（LBP）的预后研究对于了解和管理病情至关重要。本研究旨在,（1）描述基线时轻度-中度和重度疼痛和残疾的比例，1年和4年随访，和（2）在二级护理LBP患者队列中，调查4年以上疼痛和残疾改善的预后因素。
方法：这是对2011年3月至2013年10月从非手术门诊脊柱诊所招募的18-40岁LBP患者队列的二次分析（n=1037）。在基线时收集问卷，1年,4年随访。使用RolandMorris残疾问卷（RMDQ0-100）评估残疾，并使用数字评定量表（NRS0-10）评估疼痛强度。“轻度-中度疼痛”定义为NRS<7，“重度疼痛”定义为NRS≥7。同样，“轻度-中度残疾”定义为RMDQ<58.3，“重度残疾”定义为RMDQ≥58.3。在预后分析中，超过4年的疼痛和残疾改善被定义为满足两个标准:NRS降低≥2,RMDQ降低≥20.8.通过多因素logistic回归评估16个候选预后因素。
结果：在所有三个时间点都有信息的患者中（n=241），54%/48%有持续性轻度-中度疼痛/残疾，而只有7％/15％有持续的严重疼痛/残疾。在多变量预后分析中纳入的关于4年以上改善的患者中（n=498），32%的患者在4年后疼痛和残疾得到改善。发现疼痛强度呈正相关(OR1.34[95CI:1.17-1.54])，残疾（OR1.01[1.00-1.02]），和正常就业或学习（OR1.67[1.06-2.64]），与发作持续时间(OR0.99[0.99-1.00])和持续性疼痛风险(OR0.58[0.38-0.88])呈负相关.
结论：在二级护理中患有持续性LBP的患者在所有三个时间点均表现为轻度-中度疼痛和残疾。很少有持续严重的症状超过4年。此外，大约一半的纳入患者在疼痛和残疾方面有所改善.我们发现疼痛强度，残疾,发作持续时间,定期就业或学习，持续性疼痛的风险预测长期改善。然而,完整随访数据的可获得性有限可能会影响普适性.
方法：这是对2011年3月至2013年10月从非手术门诊脊柱诊所招募的18-40岁LBP患者队列的二次分析（n=1037）。在基线时收集问卷，1年,4年随访。使用RolandMorris残疾问卷（RMDQ0-100）评估残疾，并使用数字评定量表（NRS0-10）评估疼痛强度。“轻度-中度疼痛”定义为NRS<7，“重度疼痛”定义为NRS≥7。同样，“轻度-中度残疾”定义为RMDQ<58.3，“重度残疾”定义为RMDQ≥58.3。在预后分析中，超过4年的疼痛和残疾改善被定义为满足两个标准:NRS降低≥2,RMDQ降低≥20.8.通过多因素logistic回归评估16个候选预后因素。
结果：在所有三个时间点都有信息的患者中（n=241），54%/48%有持续性轻度-中度疼痛/残疾，而只有7％/15％有持续的严重疼痛/残疾。在多变量预后分析中纳入的关于4年以上改善的患者中（n=498），32%的患者在4年后疼痛和残疾得到改善。发现疼痛强度呈正相关(OR1.34[95CI:1.17-1.54])，残疾（OR1.01[1.00-1.02]），和正常就业或学习（OR1.67[1.06-2.64]），与发作持续时间(OR0.99[0.99-1.00])和持续性疼痛风险(OR0.58[0.38-0.88])呈负相关.
结论：在二级护理中患有持续性LBP的患者在所有三个时间点均表现为轻度-中度疼痛和残疾。很少有持续严重的症状超过4年。此外，大约一半的纳入患者在疼痛和残疾方面有所改善.我们发现疼痛强度，残疾,发作持续时间,定期就业或学习，持续性疼痛的风险预测长期改善。然而,完整随访数据的可获得性有限可能会影响普适性.
